Vehicle must be road registered and be below 90DBA as per ACT Regulatory Country

Emergency Contact Information
*

First Name Last Name

Phone Number
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Relationship.
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Skid Pan
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Skid Pan Fee
$
160.00
AUD

Total
$
0.00
AUD

Credit Card Details

First Name

Last Name

Credit Card Number

Security Code

Card Expiration

Informed Consent and Acknowledgement

Fifth Gear Motoring terms & conditions

I {driversName}hereby agree to be bound to the following terms and conditions:

1. Fifth Gear Motoring reserves the rights at any stage and without compensation or refund of any fee paid by me, to forthwith in its absolute remove me from any course.

2. I understand that participating in Fifth Gear Motoring programs carries a degree of risk to the person and property. Knowing the risk I still intend to participate and hereby expressively agree to assume the risk of injury and damage while participating in any Fifth Gear Motoring event.

3. I shall at all times whilst undertaking said driving course to be subject to the directions of the servants and agents of Fifth Gear Motoring in all respects.

4. I acknowledge and declare that the motor vehicle supplied by myself to be used on the said driving course is in safe and road worthy condition and is road registered, having regard to the course and speed which will be produced and that Fifth Gear Motoring shall be under any obligation to scrutineer or examine the same at any time, not withstanding Fifth Gear Motoring shall be entitled to do so at their discretion.

5. I declare and confirm that I am physically fit and have no conditions or injuries that could be affected by my participation in the said course. I acknowledge that it is a fundamental condition of my participation in the said course that I have notified Fifth Gear Motoring and or its servants of any existing medical condition which may affect my participation in the said course and which may exacerbate or deteriorate as a result of injury sustained during the said course.

6. I am not taking any medication that would impair my faculties or otherwise affect my ability to safely control a motor vehicle.

7. I hereby consent to receive medical treatment that may be deemed necessary by Fifth Gear Motoring and or its servants in the case of injury, accident or illness in the course of undertaking a Fifth Gear Motoring course and agree to indemnify Fifth Gear Motoring in respect of such medical treatment.

8. I have a current drivers licence, the details of which are correctly recorded Above. I understand that this personal information has been collected by Fifth Gear and will not be shared to any other parties.

9. I do hereby for each of our heirs, executors and administrators release Fifth Gear Motoring and all their officials, employees, representatives or agents collectively and individually from all actions, suits, claims and demands for any loss, damage, injury or cost incurred or sustained or made by me arising directly or indirectly out of my participation in any capacity in a Fifth Gear Motoring course and furthermore I agree to indemnify Fifth Gear Motoring and their servants, representatives and agents from and against all actions, suits, claims and demands or other liability in respect of death or injury to any person including myself and the loss or damage to the property of any person, company or organization including myself however arising out of, or in conjunction with my participation in a Fifth Gear Motoring course and notwithstanding that the same may have been contributed to or caused by the negligence or fault of Fifth Gear Motoring or their officials, servants, representatives or agents.

10. I understand that Fifth Gear Motoring may take be taking photos on the day of the event. I will notify Fifth Gear on the day if I do not want to have myself or vehicle in any photographs.

Signature

Clear

Confirmation

BY ACKNOWLEDGING AND SIGNING ABOVE, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.